直肠肌鞘内结肠拖出术特有并发症的治疗和预防

Complications of Endorectal Pull through Procedure

目的 探讨减少直肠肌鞘内拖出术特有并发症及采取行之有效的治疗和预防。方法 对１３４ 例行直肠肌鞘内拖出术病例进行回顾性分析， 其中结肠拖出１２７ 例， 回肠拖出７ 例， 术后２周内出现特有并发症２８ 例（２０．６ ％ ）， 其中肌鞘感染９ 例（６ ．６％ ） 、鞘内结肠假性梗阻１４ 例（１０ ％） 、鞘内肠管上缩５ 例（３ ．７％ ）， 因特有并发症死亡３ 例（２．２ ％ ）。结果 分析３ 种特有并发症发生的原因、临床特征及防治措施， 证实手术前后采用三联药物及术中严格的无菌技术等措施将鞘内感染病例由８ ．２％ （９／９８） 降低到１ ．８％ （１／３６） ， 且无严重感染病例发生， 统计学示有显著性差异（ Ｐ＜ ０．０５） 。肌鞘内下拖的肠管腔内安放肛管导气导便能有效防止鞘内结肠产生假性梗阻。严谨的手术操作方法可基本杜绝鞘内肠管上缩。结论 直肠肌鞘内拖出术的临床应用范围较广， 认识和防止特有并发症的发生可显著提高手术的治疗效果。

Objective The purpose of this study was to review the complications of endorectal pull through procedure and establish means to minimize complications. Methods One hundred and thirty four endorectal pull through procedures including colonic pull through (127) and ileal pull through (7) were reviewed. Results Of the 28 complications, there were 9 cases of abscess formation in the muscular cuff ( 6.6% ), 14 cases of intestinal pseudo obstruction (10%) and 5 of retraction of pull through bowel ( 3.7% ). Three patients died of the complications ( 2.2% ). Perioperative administration of antibiotics and aseptic technique during operation reduced the abscess formation rate from 8.2% to 1.8% . Insertion of anorectal tube prevented pseudo obstruction. Meticulous anastomosis lessened retraction of pull through bowel. Conclusions Endorectal pull through procedure is acceptable treatment for Hirschsprung, sdiesase. The complications are preventable.